Mini IVF or IVF

[HappyFaith]

Hi-
I am 42 and my husband and I recently completed my first round of Mini-Stim IVF. 2 months of retrievals gave me 3 - 'level 4' embryos. All 3 were transferred on Day 3. I ended up having a chemical pregnancy. There are no known issues with me or my husband, other than my age.

We are wondering if we should proceed with another round of Mini IVF or go to full IVF?
Also, would it be better to wait until Day 5 for a Blastocyst culture?
And lastly, do you recommend Comprehensive Chromosome Screening?

Thanks for your input.

[Dr. Wisot]

If you have the capability of making more than one or two eggs when stimulated I would usually recommend regular IVF. In my opinion, so-called minimal stimulation is usually best applied to women who cannot produce a number of eggs under regular stimulation protocols.

The real purpose of taking embryos to the blastocyst stage is to be able to make a selection of which embryos are really best or to be able to do PGS or PGD. In your situation they likely are going to transfer four or five and you are unlikely to have more than that, needing a selection process.

You will need a number of blastocysts to do PGS (comprehensive chromosome analysis). If you can create a number of blasts then PGS might save you the heartbreak of another early pregnancy loss.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[HappyFaith]

Thanks for the input.
I have looked through SART success rates and it seems like the success rate (birth) for women my age is higher for frozen embryos transferred as opposed to fresh embryo transfer. If I did full IVF, would you recommend a freezing them before transfer?

[Dr. Wisot]

There appears to be a benefit in some patients from all-freeze cycles because of an adverse effect on implantation from the stimulation. That's a decision that your doctor has to make in your individual case.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[Delilah]

I asked about mini stim And was told it was for women 35 and under with good test results who don't want multiples or women with pcos who are high risk for ohss.
I'm neither. They said they'd start me on not high doses and if I didn't respond could raise it. I did respond. You can ask for normal ivf but ask to not start with very high doses. I was on 225 gonal. There are women on like 75 of gonal who've pcos and women on more than 300. I only added menopure late in game so mostly I only had one shot. When one ovary was 22 mm they made me take ganirelix. In mini ivf they might not make you avoid premature ovulation but bear in mind this could ruin all. Was told ganirelix is safer than Lupron but depending on patient sometimes they have to use Lupron. I didn't get ohss but did have bad bloating And cramping. Still waiting to see if embryos are good. Can't sleep!

[Dr. Wisot]

Using Lupron after the follicle has developed is not an option since the stimulation properties of the Lupron can actually trigger ovulation, the opposite effect of what you want. An antagonist like Ganirelix or Cetrotide is what's appropriate for this type of cycle to prevent premature ovulation.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California